Soon there’ll be no good patients left

‘All the good patients are dying.’ One of our nurses said this to me half an hour ago. I was distracted by an urgent need for a caffeine fix at the time. But if I didn’t grasp the profundity of her comment straight away, I certainly have now.

Because my first patient post-coffee break is a young man who has arranged to have a hair transplant in some eastern European hospital of follicular excellence. This apparently requires a whole battery of pre-operative tests, and he wants me to arrange them. Now. On the NHS.

I gently point out his slight misunderstanding of what the NHS can reasonably be expected to provide. And that, while there are some grey areas, a pre-op workup for a private Romanian Rooney-rug isn’t one of them, so he’ll need to pay for these tests himself.

This prompts a volley of Trumpeqsue fire and fury. He literally cannot believe what I am saying. Replacing his absent hair is costing him an arm and a leg, he rants without any obvious irony. He pays his taxes. He knows his rights. And, besides, he says, losing me slightly, what about all these immigrants?

Given this earbashing, and the evident futility of calm logic, I decide to cut to the chase. I explain that even if I did want to help – and I don’t – I can’t, so I won’t. At which point he leaves, and good job too, because, by this point, the words ‘slap’, ‘headed’ and ‘twat’ aren’t that far from my lips.

It’s then that my nurse’s comment comes back to me. And I think, ‘Blimey, she’s right.’

Next July, the NHS will be 70 years old. There will be few patients left whose appreciation for the system is based on a memory of what things were like before it existed. These are the ones who are genuinely grateful, have a real respect for the medical profession and are a pleasure to look after. Aricept permitting.

Then there is the much larger proportion of the population for whom the health service has been ever present and has provided, over the years, more and more. They give dewy-eyed lip service to valuing the NHS, yet are increasingly happy to abuse it, vilify those who deliver it and complain when it’s not to their liking.

And now there are those who chew your ear off when you won’t arrange pre-hair-transplant tests – a group characterised by aggressive entitlement, self-obsession and instant gratification, stirred up into a self-righteous consumerist lather by governments that encourage over-provision of risk-averse and discontinuous health care. God help us when these people get old enough to really have something wrong with them.

Yes, I’m generalising and stereotyping horribly, but that’s what happens when you have this type of consultation. Besides, I might be right: the overlooked factor when the health economists freak out about our ageing population is not the inevitable multimorbidity, but the horrific attitude developing with it. All the good patients are dying, remember? And with them, quite possibly, the NHS.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

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Readers' comments (10)

This kind of thinking is eroding the service. I was observant to a thread on facebook recently- someone who had assessed their diet and was only getting 20 percent of her iron intake. She goes to the gym 5 times a week and works full times with no signs of illness. "See your GP and get your iron levels tested" came the supportive messages... "make sure to get your magnesium checked as well". One timid person did suggest the NHS shouldn't be used for the suchlike and was ignored....

As a student I had the pleasure of consulting with a retired GP whose career began at the birth of the NHS. He recalled the late 40s/early 50s, when OOH visit requests were an excitingly rare event, with grateful patients proffering him unaccepted cash whilst apologising profusely for having the temerity to disturb him. Then in the late 50s he was hauled out of bed for a trivial childhood URTI, and when questioned the young mother retorted "but it's my right!". Fast forward to the 80s, when unquenchable demand for unwarranted visits forced him first to engage the services of a ruinously expensive locum agency, then quit GP completely.

I have recently identified an educational need. Reflecting this need to Amazon, I downloaded a copy of "Basic Economics" by Thomas Sewell to my kindle. I'm only 8% into the book and already I've learned to my astonishment [sic] that services that are provided free of charge to any given population are abused, disrespected, overwhelmed and are catastrophic economic disasters time after time.... no exceptions. The problem lies with political desire to win votes and power, promising the populace what it wants in exchange for those votes, with no regard given to those who actually provide the service or the economic impact the free provision will have. Sounds vaguely familiar and does not apply only to the NHS. 70 years have passed and we have reached a watershed in a natural evolutionary process.No time to cry.... the milk is spilt.

Recommended further reading;Brave New World Aldous HuxleyThe Prince Machiavelli

It's so true, we do our own 24hr on call and my husband was up all night after a call at 2am, acute MI, thrombolysed, transferred etc then went to work sorted the morning surgery and went home for a kip - patient turned up without an appt for a flu jag, insisted the receptionist wake him up and get him back to the surgery. They didn't care in the slightest he had been up all night with a member of their own community... this is why there is no going back for out of hours care, people have no respect for doctors as living breathing human beings and as a resource that should be used wisely.